NHS Continuing Care

[Ugly6]

Hi - I'm just beginning to investigate whether this could be a route for DM, don't really know anything about it yet but would appreciate if anyone in this group had an words of wisdom or experiences to share? My head hurts with having to try to understand more protocols and rules thanks

There's a very good explanation on YouTube, by a Professor called Luke Clements, it's worth a watch if you have an hour spare.

A simple explanation is that if the patient/ elderly person has basic care needs then it's very likely that they will not qualify for CHC.
So, if you could hire a carer and give them minimal training, but they could adequately care for the patient, then they wouldn't qualify for CHC.
A lot of elderly people would fall into this category, they might need help with getting up, washed, dressed, not be able to prepare a meal themselves, but in itself that's not a medical/ health need, it's more social care.

For CHC the patient would need nursing care, because their health needs are not basic social care, but something more complex.
The NHS is obliged to fund this care because the NHS was founded for free health care at the point of need.

The difficulty for a lot of people is trying to prove that they have complex needs!

If there's a possibility that your DM would qualify for CHC then the first stage is a checklist. It's quite straight forward and can be completed in less than half an hour by an appropriate person - nurse or social worker or similar.
Your DM and/ or her representative should be given the opportunity to be present for the checklist.

If the checklist is positive then (usually, not sure about during pandemic) a full assessment should be carried out within 28 days.
If the patient passes the full assessment then CHC is awarded, which means appropriate care is funded, and it's not means tested.

If the patient doesn't score highly enough then they won't receive the CHC funding and would then face having a financial assessment to see how they can contribute themselves.
There's a further payment that can be made from CHC but not the full amount, if your DM was in a nursing home.

If your mother has a social worker, get in touch and ask them to go through the 'checklist'. This is the initial stage which will determine whether the full process needs to be followed. If they don't have a SW call your local authority adult services and request the assessment anyway.

CHC is notoriously hard to get. The bar is set pretty low to 'check in' at the initial stage then raised right up for the second/ deciding part.

As the PP has said, your mum will need to have what's called a primary health care need- anything above and beyond what carers or bog standard residential care can offer. For example, extremely significant challenging behaviour, continence care that's is way outside of routine (complicated stoma care) just to name a few.

It's really important to go through the process for all clients IMO as like has been said above, individuals legally shouldn't pay for needs identified and being primary health.

Go onto your local CCG page and download the easy read guidance on chc- it should help.

Also, is your mum living at home/ in the community still? If so check the daily logs left by carers (if you have them) are robust and detail every bit of support they provide, any challenges etc. If it's family providing the support then start keeping logs yourself. The deciding part of the process needs evidence to back up any support needed.
Good luck x

I looked into CHC a few years ago, had quite a journey with it to say the least.
I read the National Framework over and over again, read through post after post on the Dementia website forums, and had many a sleepless night.

Is there anything specific you want to know?

The different levels of care funding:

Primary NHS care funded by the NHS and provided by GPs, District Nurses and hospitals.

Social care - funds things like washing, dressing, making meals, personal care (continence etc) safety checks. GPs and district nurses are able to meet any health/nursing needs.

Social care can be provided in someone's own home or in residential or nursing care. It's funded by either the local authority or by the person/their family.

Residential care - usually people become eligible for residential care when they need someone to be available on hand most of the time during the day because they can't manage by themselves in between care visits or over night. GPs and district nurses continue to be the professionals who meet any health/nursing needs

Nursing care - same criteria as residential care however the district nurses no longer provide the nursing care as if someone is eligible for nursing care they usually have higher nursing needs than can be met by district nurses. Their nursing needs are instead met by nurses employed by the nursing home. Because this is a health need the nursing care is funded by the NHS and is called the Funded Nursing Contribution (FNC). This is £187.60 a week and paid to the nursing home by the NHS separately to any social care fees paid by the council/family.

Fully funded continuing healthcare

Fully funded continuing healthcare becomes applicable in two situations. The first one is where someone's care needs are so heavily dependent on skilled staff meeting health needs that the £187.60 a week is no longer sufficient to fund their nursing requirements. This will be because the nature of their health care needs are so unpredictable, complex or intense that it is beyond what is lawful for someone to fund as a social care need because it is now a primary healthcare need.

The second situation where fully funded continuing healthcare applies is where someone is rapidly deteriorating and has enter enter the terminal phase of their life. This is known as 'fast track continuing healthcare'.

@hatgirl has given an excellent summary !!

OP, if you look around the HMGov website on continuing health care including reading intro, the link to CHC national framework , link to CHC checklist and link to CHC decision support tool you'll get a good sense of how high needs have to be to meet CHC eligibility criteria.

www.gov.uk/government/collections/nhs-continuing-healthcare-and-nhs-funded-nursing-care

Whoops wrong starting link

www.gov.uk/government/publications/nhs-continuing-healthcare-and-nhs-funded-nursing-care-public-information-leaflet

It's an absolute bugger to get and I'm only just getting over the disappointment of being declined 18 months ago, despite the district nurses telling me we'd definitely qualify.

What stung was how shit life was at the time, but according to them, it wasn't shit enough. I cried buckets all day.

I'm just waiting for him to get even worse before I try again. :(

Good luck. One decent piece of advice I read was to keep a diary and catalog every event and difficulty so you can produce it as evidence. Further to that, do some research before the assessment so you know what sorts of words to use. "Unpredictable" is a good one.

Wish we could edit - Sorry, to clarify, it's my dad who's the patient.

Contact these people:www.beaconchc.co.uk/

Or pm me - I have just successfully appealed two refusals for my OH, who has since died.